Cure should not be worse than disease

Healthcare reform is at the top of nearly everyone’s agenda, and for good reason. Too many Americans are uninsured or underinsured. Those who do have coverage don’t always get the care or choices they should. And costs are spiraling upward, putting a strain on families, businesses and governments at every level.

Given these challenges, it seems safe to move beyond the question of whether we need reform to focus our attention on how that reform should be accomplished. Because the how matters. If we don’t approach healthcare reform carefully, we could destroy one of the few parts of the system that actually works.

This, of course, is the employment-based health coverage structure, rooted in the Employee Retirement Income Security Act. ERISA provides a framework for employers to offer, on a voluntary basis, consistent, high-quality, cost-effective health benefits to workers all across the country. And the bedrock principle that makes this possible is ERISA’s preemption of state and local coverage mandates.

ERISA creates uniform federal standards for employer-sponsored plans. By preempting state and local laws, ERISA makes it possible for employers to offer the same health coverage to their workers regardless of where they live and work. This helps to hold down costs and ensure consistent benefits. This law is good for both workers and employers.

Unfortunately, some of the hallmarks of ERISA that have made it so successful are now coming under attack. For instance, the federal ERISA law was deliberately structured with minimal health coverage benefit mandates in order to keep costs low. Yet numerous proposals have surfaced to add new federal mandates, all of which would drive up costs and, more likely than not, drive many employers and their workers out of the system entirely.

There are other dangerous proposals on the table as well.

For instance, there are proposals to permit “waivers” from ERISA preemption that would enable state and local governments to adopt “pay or play” laws. Generally, under pay or play laws, new taxes are levied against employers that do not meet arbitrary healthcare spending mandates that would be determined by state and local governments. Either way, employers would pay.

Businesses would have to absorb the extra costs, pass them along to workers and consumers, or drop health coverage altogether.

Still another threat to employer-sponsored health coverage is the plan to cement retiree healthcare benefits. Under this proposal, once an employer offers a retiree health benefit, it would be locked into providing exactly the same benefit in exactly the same manner, no matter how circumstances may change in the future. Limiting flexibility would have dire consequences, and could doom these voluntarily provided benefits for all workers.

Taken together, these proposals are nothing less than an assault on one of the most successful elements of the healthcare system in this country. The cold, hard truth is that adding ever more health coverage mandates and chipping away at ERISA preemption would be the beginning of the end of employer-based healthcare. Employer-based health coverage is a voluntary benefit. The more costly and complex the government makes it, the less likely employers are to offer it.

Of course, we must not bury our heads in the sand and act as if there is no need for reform. We face a deteriorating economy and fast-rising healthcare costs that make it harder to provide affordable, quality benefits. Far too many businesses, especially small businesses, are unable to provide coverage to their workers.

To help solve these problems, House Republicans have convened a healthcare task force. I’m proud to be a member of this innovative group, which will work in the coming months to propose alternatives to the European-style model of one-size-fits-all care and government rationing that seems to be gaining favor.

There’s a statistic that’s thrown around a lot in the healthcare debate: the fact that there are about 46 million people in America without health insurance. There is no question that this is an unacceptable figure, and there are many things we can and should do to provide coverage to the uninsured. But as Congress prepares to overhaul America’s healthcare system, we must not forget about the 130 million-plus Americans who are covered by employment-based ERISA health plans.

This is the most common type of coverage for workers under age 65, and overall satisfaction levels are high. Let’s not embrace a cure for what ails our healthcare system that would dismantle one of the few areas that is actually working.

McKeon is ranking member of the House Committee on Education and Labor.